How the Current Vaccine Environment Could Impact Uptake Among Adults Ages 50 and Older

AARP PUBLIC POLICY INSTITUTE

APRIL 2021

Insight on the Issues The COVID-19 Vaccine Rollout: How the Current Vaccine Environment Could Impact Uptake among Adults Ages 50 and Older

James McSpadden, Elizabeth Carter, and Olivia Dean AARP Public Policy Institute

In February 2021, the United States reached a grim milestone: more than 500,000 American deaths from COVID-19 and over KEY TAKEAWAYS 28 million cases, according to the Centers for Disease Control 9 Attitudes about and access to and Prevention (CDC). While the rate of deaths is slowing, COVID-19 vaccines influence another 52,000 Americans have died since reaching the half- vaccination behavior. million mark. Notably, over 90 percent of COVID-19-related deaths are among adults ages 50 and older, especially those ages 9 Prior to COVID-19 vaccine 85 and older.1 rollout, more than half of The virus hits older adults of color particularly hard. Black, adults ages 50 and older Hispanic, and American Indian/Alaska Native adults contract who indicated being unlikely COVID-19 at greater rates compared with Whites, relative to to get a COVID-19 vaccine their population, and die from the virus at 2 to 2.5 times the reported concerns about the rate.2 Nursing homes with higher proportions of Black and vaccine’s safety or efficacy. Hispanic residents report over 3 times as many deaths as do 9 Among this group, Black 3 homes with more White residents. and Hispanic respondents Many older adults eagerly anticipated the arrival of vaccines were more likely than White as critical in the fight against COVID-19. A 2020 AARP survey respondents to identify such revealed that 65 percent of adults ages 50 and older said that concerns. they would likely get the vaccine when it becomes available, 9 Despite strong early including 74 percent of those ages 65 and older.4 A subsequent vaccination rates among survey in January 2021 showed the likelihood among adults older adults, access barriers, ages 50 and older had increased to 80 percent.5 such as vaccination sites Despite these strong responses, access barriers may prevent not matching older adults’ or delay vaccine uptake among older adults. The uneven preferred vaccination distribution of an increasing but limited supply of COVID-19 settings, could limit uptake of vaccine doses may leave behind those who face greater access COVID-19 vaccination if not 6 barriers. Recent data on COVID-19 vaccine administration addressed. reveal the exacerbation of longstanding racial and ethnic AARP PUBLIC POLICY INSTITUTE

APRIL 2021

KEY TERMS

Vaccine Attitudes The perceptions, values, and beliefs that an individual has toward vaccines. Vaccine attitudes influence behavior. Vaccine Behavior The way in which an individual acts regarding vaccinations, including accepting, postponing, or refusing vaccinations. Vaccine Barriers The personal and structural impediments that prevent access to vaccination. Vaccine Hesitancy The delay in acceptance or refusal of vaccines, despite their availability. Vaccine hesitancy is a form of vaccine behavior that can result from unfavorable vaccine attitudes.*

* Report of the SAGE Working Group on Vaccine Hesitancy (October 2014), World Health Organization, https://www.who.int/ immunization/sage/meetings/2014/october/1_Report_WORKING_GROUP_vaccine_hesitancy_final.pdf.

disparities. While Black and Hispanic Americans evaluated the trial data and issued Emergency represent 13 and 19 percent of the United States Use Authorizations for three COVID-19 vaccines population, respectively, national vaccination between late 2020 and early 2021.8 data indicate only 8 percent of vaccine doses Simultaneously, federal and state officials worked administered as of March 2021 had gone to Black 7 to determine who should receive the initial adults and 9 percent had gone to Hispanic adults. doses as they became available. The Advisory At a time when officials are encouraging everyone Committee on Immunization Practices, a group of to get vaccinated once the vaccine becomes medical and public health experts that develops available to them, understanding why older adults recommendations on the use of vaccines, released might not be getting the COVID-19 vaccine is a vaccine allocation framework identifying adults critical. This report examines the current vaccine ages 65 and older as one of the first groups that landscape and explores how key factors—including should receive the COVID-19 vaccine.9 Although unfavorable attitudes toward vaccines and states were free to deviate from this framework, vaccination access and infrastructure—may limit most prioritized older adults in their initial the number of adults ages 50 and older receiving vaccination plans.10 During implementation, some COVID-19 vaccines. The report also discusses racial states made small refinements regarding older and ethnic disparities in vaccine attitudes and adults, such as elevating certain age groups (e.g., access and presents several policy and practice adults ages 75 and older) to receive vaccinations recommendations to help mitigate vaccination sooner or broadening prioritization tiers to include barriers and improve vaccination rates for older additional populations alongside older adults.11 adults. Data from the COVID-19 vaccine rollout show a positive response among many older adults. COVID-19 VACCINATION AMONG OLDER ADULTS Surveys continue to suggest growing favorability Since the start of the pandemic, scientists have toward COVID-19 vaccines. In November, a moved at unprecedented speed to help develop, University of Michigan Health Aging poll revealed test, and distribute a vaccine against COVID-19. A that 58 percent of adults ages 50 and older number of companies quickly launched clinical indicated they would be likely to get a COVID-19 trials, which included cohorts of older adults, in vaccine, with higher rates among adults ages order to test the safety and efficacy of potential 65 and older.12 The March 2021 Kaiser Family vaccines. The Food and Drug Administration (FDA) Foundation COVID-19 Vaccine Monitor indicated

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that 64 percent of adults ages 65 reported they vaccine’s side effects. Nearly a third (29 percent) had already received at least one dose and another believed a vaccine would not protect them or 17 percent reported that they wanted to get would not work, and 16 percent perceived that they vaccinated as soon as possible.13 At the end of were healthy and did not need a vaccine. Desire to March, the White House reported that 50 percent of avoid health care sites and a lack of concern about adults ages 65 and older were fully vaccinated and contracting the virus were the least-cited reasons some 73 percent had received at least one dose.14 for planning to forgo a vaccine (13 and 12 percent, respectively). VACCINE ATTITUDES, BEHAVIOR, AND HESITANCY Another factor that could be driving COVID-19 AMONG OLDER ADULTS vaccine hesitancy is mistrust. The 2020 AARP Vaccine attitudes are the perceptions, values, and survey found that older Americans report only beliefs an individual has toward vaccines that moderate levels of trust in local and national contribute to his or her decision of whether to organizations to provide factual information about accept or forgo vaccination. These attitudes may be the COVID-19 vaccine. Approximately half of positive or negative, relate to matters of vaccination respondents considered local hospitals and health confidence, complacency, or convenience, and stem officials (51 percent), the CDC (46 percent), and the from a variety of factors, including the perceptions FDA (42 percent) to be honest sources of factual and experiences of family and friends, information information about the COVID-19 vaccine. Providers collected from various sources, and previous are generally more trusted sources, with 74 percent experiences with vaccines.15 Vaccine attitudes can of AARP survey respondents identifying their also influence vaccine hesitancy, which is the delay provider as the most trusted source of information in acceptance or refusal of vaccines despite their about vaccines. availability.16 Racial and Ethnic Differences in Vaccine Attitudes The 2020 AARP survey of older adults’ likelihood The 2020 AARP survey also found substantial of getting a COVID-19 vaccine illuminated how differences in attitudes toward COVID-19 vaccines vaccine attitudes can influence behavior (figure 1). by race and ethnicity (figure 2). Black and Among the 34 percent of respondents who reported Hispanic older adults who indicated they were being somewhat or very unlikely to get a COVID-19 unlikely to get a COVID-19 vaccine were more vaccine, many raised safety and efficacy concerns worried about the vaccine’s side effects (63 and about the vaccines. Over half (59 percent) of this 69 percent, respectively) compared with their White group reported being concerned about a COVID-19 counterparts (55 percent). Among this vaccine-

FIGURE 1 Attitudes among Adults Ages 50 and Older Who Are Unlikely to Get a COVID-19 Vaccine

Worried about side effects 59%

Vaccine will not protect me/doesn’t work 29%

Healthy and don’t need a vaccine 16%

Keeping away from heath care sites because of COVID-19 13%

Not concerned what will happen if I contract the virus 12%

Source: 2020 AARP Vaccine Survey

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FIGURE 2 Attitudes among Adults Ages 50 and Older Who Are Unlikely to Get a COVID-19 Vaccine, by Race and Ethnicity

Hispanic Black White

69% Worried about side effects 63% 55% 38% Vaccine doesn’t work very well 30% 28% 14% Healthy and don’t need a vaccine 13% 18% 27% Keeping away from heath care sites because of COVID-19 11% 12% 10% Not concerned what will happen if I contract the virus 10% 8% 42% Do not trust the government 67% 42%

Source: 2020 AARP Vaccine Survey hesitant group, Hispanic respondents had greater there continue to be some attitude differences concern about the vaccine’s efficacy (38 percent) among racial groups. The March 2021 Kaiser Family than did White (28 percent) or Black (30 percent) Foundation COVID-19 Vaccine Monitor found older adults. Hispanics were also more likely that White respondents were most likely to report to avoid health care sites because of COVID-19 definitely not wanting to get the vaccine, though (27 percent) than were their White (12 percent) and Black respondents were more likely than were Black (11 percent) counterparts. Over two-thirds White or Hispanic respondents to report wanting of Black respondents in this group (67 percent) to “wait and see” how the vaccine works for others expressed a lack of trust in the government, a before getting vaccinated.21 significantly higher share than among White or Misinformation also intensifies mistrust and Hispanic respondents (both 42 percent). vaccine hesitancy among older adults. Research These attitudes are not surprising. Centuries of indicates that older adults, particularly those racism and medical mistreatment have fueled ages 65 and older, are highly susceptible to longstanding medical mistrust among communities misinformation, especially from digital sources 17 of color. Such issues remain pervasive in US and social media platforms.22 Compounding this health care, contributing to health disparities and susceptibility is the fact that groups seeking to playing a role in vaccine hesitancy for many older 18,19,20 sow misinformation about the COVID-19 vaccine adults. target the Black community and other groups Recent surveys indicate that opposition to getting with existing skepticism about the medical a COVID-19 vaccine is diminishing overall, but establishment.23

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VACCINE ACCESS AND INFRASTRUCTURE Using the Existing Infrastructure for COVID-19 Part of the vaccine decision-making process is Vaccine Distribution determining where to get a vaccine. Traditionally, In the rollout of COVID-19 vaccines to the public, adults traveled to health care settings (e.g., primary most states have pursued opportunities for care provider’s office, hospital, health department, quick and wide distribution, supplementing the community-based clinic) to get vaccinated. existing immunization infrastructure (including However, as the vaccine infrastructure has shifted health systems and pharmacies) with more to make vaccines more accessible, some adults opt nonconventional settings. For example, many to use nontraditional settings for vaccinations, such states are holding mass vaccination events or as pharmacies, grocery stores, and workplaces. using mobile clinics to reach older adults in rural and underserved areas, while others are engaging This multi-setting environment has contributed 24 nontraditional providers such as health professional to increasing flu vaccination rates. While adults students, dentists, and paramedics to increase the ages 50 and older most frequently go directly to direct care workforce available across a variety of their health care provider (40 percent) to receive 27 settings. a flu vaccination (figure 3), a similar share visit supermarkets and pharmacies (35 percent) to get flu States are also facing vaccine distribution shots. Additionally, some older adults (9 percent) opt challenges. Requirements to keep the first to get flu vaccines at their place of work.25 authorized COVID-19 vaccines in ultra-cold temperatures (ranging from –112 to –15 degrees Preferred locations for flu vaccinations differ by 26 Fahrenheit, depending on the vaccine) limits which race and ethnicity. A health provider’s office entities can receive and store the vaccines, resulting is the preferred location for receiving flu shots in hospitals and large provider settings receiving among most racial and ethnic groups. White, Black, 28 and Asian adults are most likely to get their flu the bulk of initial doses. In addition, as of early vaccination in this setting, while Hispanic adults 2021, delays in distribution and insufficient supplies are equally likely to go to another setting (e.g., have prevented some states from utilizing primary hospital, community health clinic). White adults are care providers and pharmacies to a greater extent. more likely than other racial and ethnic groups to In other words, state plans for vaccination get vaccinated at a pharmacy or supermarket. administration currently do not mirror the existing

FIGURE 3 Where Adults Ages 50 and Older Report Getting Flu Shots, 2019

40% 35%

9% 7% 4% 4%

Health care Pharmacy or Workplace Clinic or Hospital Other provider supermarket health center Source: AARP Public Policy Institute Analysis of Behavioral Risk Factor Surveillance System data

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patterns of vaccine behavior among older adults. to 20 percent in January 2021, according to AARP Such differences could have implications for surveys. Only 15 percent of adults ages 65 and older COVID-19 vaccination efforts. A shift away from reported they would probably or definitely not trusted settings and familiar processes for getting get a COVID-19 vaccine, according to the March vaccinations has contributed to the widespread 2021 Kaiser Family Foundation COVID-19 Vaccine confusion about how to get a vaccine, questions Monitor.35 Even so, efforts must continue to address about when and how one becomes eligible to get lingering concerns about the vaccine among those a vaccine, distrust toward groups involved in who remain hesitant. The vaccine infrastructure vaccine administration, and, ultimately, delays in also plays a significant role in vaccine uptake, and vaccination.29 lack of access to vaccinations through preferred Unorthodox COVID-19 vaccination efforts may and trusted sources can hinder uptake. Racial and create access barriers for individuals familiar with ethnic differences in attitudes toward and disparate only traditional vaccine systems. For example, access to COVID-19 vaccines can also contribute to online registration can make it difficult for those disparities in vaccination rates. without a computer, reliable Internet, or computer Health officials and providers have the dual literacy to make an appointment or find out where challenges of effectively managing vaccine to receive a vaccine, exacerbating a digital divide distribution and administration for older adults and that disadvantages older adults, rural residents, and combatting negative vaccine attitudes and vaccine people of color.30 Further, even if someone can get an hesitancy. Quickly and efficiently addressing these appointment, early reports indicate that COVID-19 challenges to turn vaccines into vaccinations will vaccination sites are mostly located in neighborhoods require strong coordination across health and with higher shares of White and affluent residents.31 government sectors and increased resources for As a result, people who do not live in such public health, and attention to the unique issues neighborhoods may have to travel a considerable facing specific populations. distance to get a vaccine, creating barriers for many older adults, low-income individuals, and people POLICY AND PRACTICE RECOMMENDATIONS of color who lack transportation to travel to the vaccination sites.32 In fact, a recent survey found Vaccine Attitudes, Behavior, and Hesitancy that, among people still deciding whether to get • To improve trust in COVID-19 vaccines vaccinated, Hispanic and Black respondents had among older adults, local officials should more concerns about transportation to a vaccination communicate clearly with the public regarding site or having to take time off work to get vaccinated the development and administration of vaccines than did White respondents.33 and put in place transparent and equitable vaccination plans. CONCLUSIONS • Providers should routinely explain the risks and The distribution of COVID-19 vaccines is occurring benefits of vaccination to older patients as well at a time when millions of older adults are as communicate with clarity and consistency to already going without recommended vaccines, allay concerns and build trust. including vaccines to prevent and limit the effects • Health officials should conduct robust, of influenza, pneumonia, and shingles.34 If not linguistically and culturally appropriate outreach addressed, negative attitudes about the COVID-19 and education campaigns to reach diverse vaccine and access barriers could limit COVID-19 communities, partnering with influential vaccination rates among older adults. The share community leaders to serve as trusted of older adults reporting they would likely not get messengers about vaccines (e.g., Black church the COVID-19 vaccine continues to shrink during leaders and Native American elders). Officials rollout. The percentage of adults ages 50 and should include trusted leaders and organizations older dropped from 34 percent in October 2020 in vaccination outreach and education programs

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throughout all phases, including planning, • Registration for vaccinations should be easily implementation, and evaluation. accessible by phone or onsite at vaccination Messages to encourage vaccine uptake should clinics in addition to online, in order to reach • older adults, rural residents, and people of color focus on matters related to confidence, such as the safety and efficacy of each vaccine. who may not have broadband at home. States should utilize both traditional vaccination Providers and other health professionals involved • • settings and new, supplemental settings to in vaccine administration should participate in increase vaccine uptake. Officials should base training on explicit and implicit bias, cultural new efforts on evidence of consumer preferences competence and humility, and antiracism. and ensure equity in their approach. Officials should monitor the long-term impacts • Policy makers should strengthen the existing of outreach and education campaigns and • vaccine infrastructure and ensure vaccination continue to track vaccine confidence and sites are equitably distributed and widely hesitancy. Successful efforts should be scaled, as available in communities that have been appropriate. disproportionately impacted by COVID-19. Vaccine Access and Infrastructure • Vaccination settings should be widely accessible, • To the extent that they are able, providers convenient, trusted, and safe. Officials should should check in with and inform patients about disseminate information about vaccination COVID-19 vaccination eligibility and direct them locations, mark locations clearly, ensure sites are to and assist them with vaccination registration well served by public transit, and provide free when they become eligible. transit to sites.

1 “Demographic Trends of COVID-19 Cases and Deaths in the United States Reported to CDC,” CDC COVID Data Tracker, accessed April 1, 2021, https://covid.cdc.gov/covid-data-tracker/#demographics. 2 “Risk for COVID-19 Infection, Hospitalization, and Death By Race/Ethnicity,” CDC, accessed April 1, 2021, https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations-discovery/hospitalization-death-by-race-ethnicity.html. 3 Rebecca J. Gorges and R. Tamara Konetzka, “Factors Associated with Racial Differences in Deaths among Nursing Home Residents with COVID-19 Infection in the US,” JAMA Network Open 4, no. 2 (2021): e2037431, doi:10.1001/jamanetworkopen.2020.37431. 4 Cheryl Lampkin, 2020 AARP Vaccine Survey (Washington, DC: AARP Research, February 2021), https://www.aarp.org/ research/topics/health/info-2021/vaccination-acceptance-older-adults.html. 5 Teresa A. Keenan, Cheryl Lampkin, and Gerard Rainville, Views on Vaccines and More—Mid-COVID: A Look at Gender Differences (Washington, DC: AARP Research, March 2021), doi:10.26419/res.00448.001. 6 Michelle M. Hughes, et al., “County-Level COVID-19 Vaccination Coverage and Social Vulnerability—United States, December 14, 2020–March 1, 2021,” MMWR Morbidity and Mortality Weekly Report, ePub March 17, 2021, doi:10.15585/mmwr.mm7012 e1external icon. 7 Race and ethnicity identifiers are available for slightly more than half of the individuals who have received a vaccine. See “Demographic Characteristics of People Receiving COVID-19 Vaccinations in the United States,” CDC COVID Data Tracker, accessed March 22, 2021, https://covid.cdc.gov/covid-data-tracker/#vaccination-demographic. 8 Emergency Use Authorization (EUA) differs from full drug approval. When the Department of Health and Human Services declares an emergency, the FDA can issue an EUA if it reasonably believes that the drug’s benefits outweigh its risks, that it may be effective, and that no alternative drugs are available. For more on the FDA’s use of Emergency Use Authorization, see “Emergency Use Authorization for Vaccines to Prevent COVID-19: Guidance for Industry,” FDA, February 2021, https://www.fda.gov/regulatory- information/search-fda-guidance-documents/emergency-use-authorization-vaccines-prevent-covid-19.

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9 Kathleen Dooling, et al., “The Advisory Committee on Immunization Practices’ Updated Interim Recommendation for Allocation of COVID-19 Vaccine—United States, December 2020,” MMWR Morbidity and Mortality Weekly Report 69 (2021): 1657–60, doi:10.15585/mmwr.mm695152e2. 10 Initial state plans available at “COVID-19 Vaccination Plans by State,” Duke-Margolis Center for Health Policy, December 9, 2020, https://healthpolicy.duke.edu/news/covid-19-vaccination-plans-state. 11 “State COVID-19 Vaccine Priority Populations,” Kaiser Family Foundation, accessed March 1, 2021, https://www.kff.org/ b f a 2 7a 7/. 12 Preeti Malani, et al., “National Poll on Healthy Aging: Older Adults’ Perspectives on a COVID-19 Vaccine” (Ann Arbor: University of Michigan, November 2020), http://hdl.handle.net/2027.42/163523. 13 Liz Hamel, et al., “KFF COVID-19 Vaccine Monitor: March 2021,” (Washington, DC: Kaiser Family Foundation, March 2021), https://www.kff.org/coronavirus-covid-19/poll-finding/kff-covid-19-vaccine-monitor-march-2021/. 14 Andy Slavitt, et al., “Press Briefing by White House COVID-19 Response Team and Public Health Officials,” Teleconference, March 29, 2021. Accessed on April 1, 2021, https://www.whitehouse.gov/briefing-room/press-briefings/2021/03/29/press- briefing-by-white-house-covid-19-response-team-and-public-health-officials-21/. 15 Report of the SAGE Working Group on Vaccine Hesitancy (October 2014), World Health Organization, https://www.who.int/ immunization/sage/meetings/2014/october/1_Report_WORKING_GROUP_vaccine_hesitancy_final.pdf. 16 Vaccine hesitancy, as defined by the World Health Organization, is the delay in acceptance or refusal of vaccines, despite their availability. Vaccine hesitancy is a form of vaccine behavior that can result from unfavorable vaccine attitudes. For more on vaccine hesitancy among older adults, see James McSpadden, Vaccine Hesitancy among Older Adults, with Implications for COVID-19 Vaccination and Beyond (Washington, DC: AARP Public Policy Institute, February 2021), doi:10.26419/ppi.00123.001. 17 Alexandra Stern, “Forced Sterilization Policies in the US Targeted Minorities and Those with Disabilities—and Lasted into the 21st Century,” (Ann Arbor: University of Michigan, September 23, 2020), https://ihpi.umich.edu/news/forced- sterilization-policies-us-targeted-minorities-and-those-disabilities-and-lasted-21st; Alex Shashkevich, “Stanford Scholar Traces Medical Experimentation on Slaves in 18th-Century Caribbean Colonies,” Stanford News, August 17, 2017, https://news.stanford.edu/2017/08/10/medical-experimentation-slaves-18th-century-caribbean-colonies/. 18 Kelly M. Hoffman, et al., “Racial Bias in Pain Assessment and Treatment Recommendations, and False Beliefs about Biological Differences between Blacks and Whites,” Proceedings of the National Academy of Sciences 113, no. 16 (2016): 4231–33, doi:10.1073/pnas.1516047113. 19 Gilbert C. Lee and Chandra L. Ford, “Structural Racism and Health Inequities,” Du Bois Review 8, no. 1 (2011): 115–32, doi:10.1017/S1742058X11000130. 20 Fran Kritz, “Trusted Messengers, Trusted Messages: How to Overcome Vaccine Hesitancy,” NPR, December 24, 2020, https://www.npr.org/sections/health-shots/2020/12/24/948776228/trusted-messengers-trusted-messages-how-to- overcome-vaccine-hesitancy. 21 Hamel, et al., “KFF COVID-19 Vaccine Monitor: March 2021.” 22 Santosh Vijaykumar, “Covid-19: Older Adults and the Risks of Misinformation,” The BMJ Opinion (blog), March 13, 2020, https://blogs.bmj.com/bmj/2020/03/13/covid-19-older-adults-and-the-risks-of-misinformation/. 23 Peter Jamison, “Anti-vaccination Leaders Fuel Black Mistrust of Medical Establishment as Covid-19 Kills People of Color,” Washington Post, July 17, 2020, https://www.washingtonpost.com/dc-md-va/2020/07/17/black-anti-vaccine-coronavirus- tuskegee-syphilis/. 24 Namhoon Kim and Travis P. Mountain, “Role of Non-traditional Locations for Seasonal Flu Vaccination: Empirical Evidence and Evaluation,” Vaccine 35, no. 22 (2017): 2943–48. 25 Although data are not available on the specific patterns of utilization for shingles and pneumococcal vaccines, evidence suggests that many older adults who vaccines are likely to get them from either their provider or a pharmacy. The CDC’s website promotes these two settings as the principal places to receive either vaccine, and most states have passed laws allowing pharmacies to administer both vaccines.

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26 Krutika Amin, et al., “Where Do Americans Get Vaccines and How Much Does It Cost to Administer Them?”, Peterson-KFF Health System Tracker, February 12, 2021, https://www.healthsystemtracker.org/chart-collection/where-do-americans-get-vaccines- and-how-much-does-it-cost-to-administer-them/. 27 Eric Goralnick, Christoph Kaufmann, and Atul A. Gawande, “Mass-Vaccination Sites—An Essential Innovation to Curb the Covid-19 Pandemic,” NEJM Perspective, March 10, 2021, doi:10.1056/NEJMp2102535. 28 Pfizer recently revised, and FDA approved, the vaccine’s storage requirements. See FDA, “Coronavirus (COVID-19) Update: FDA Allows More Flexible Storage, Transportation Conditions for Pfizer-BioNTech COVID-19 Vaccine,” February 25, 2021, https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-allows-more-flexible-storage- transportation-conditions-pfizer. 29 Phil Galewitz, “Covid Vaccine Rollout Leaves Most Older Adults Confused Where to Get Shots,” Kaiser Health News, January 22, 2021, https://khn.org/news/article/covid-vaccine-rollout-leaves-most-older-adults-confused-where-to-get-shots/. 30 Nicol Turner Lee, “Closing the Digital and Economic Divides in Rural America,” Brookings, https://www.brookings.edu/ longform/closing-the-digital-and-economic-divides-in-rural-america/. 31 Sean McMinn, et al., “Across The South, COVID-19 Vaccine Sites Missing from Black and Hispanic Neighborhoods,” NPR, February 5, 2021, https://www.npr.org/2021/02/05/962946721/across-the-south-covid-19-vaccine-sites-missing-from-black- and-hispanic-neighbor. 32 Jenni Bergal, “Without a Ride, Many in Need Have No Shot at COVID-19 Vaccine,” Pew Stateline, February 1, 2021, https://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2021/02/01/without-a-ride-many-in-need-have-no- shot-at-covid-19-vaccine. 33 Hamel, et al., “KFF COVID-19 Vaccine Monitor: February 2021.” 34 James McSpadden and Elizabeth Carter, Influenza Vaccinations among Adults 50 and Older: Slow Progress over the Past Decade (Washington, DC: AARP Public Policy Institute, September 2020), doi:10.26419/ppi.00110.001. 35 Lampkin, 2020 AARP Vaccine Survey; Keenan, et al., Views on Vaccines and More; Hamel, et al., “KFF COVID-19 Vaccine Monitor: March 2021.”

Insight on the Issues 156, April 2021

For more reports from the Public Policy Institute, visit http://www.aarp.org/ppi/.

https://doi.org/10.26419/ppi.00136.001